Key result
Volume expansion, inotrope withdrawal, and vasopressors rapidly relieve dynamic SAM in post-CABG cardiogenic shock.
Why the study?
Dynamic LVOT obstruction is rarely seen after nonmitral cardiovascular surgery, can cause hemodynamic instability or shock, and requires management significantly different from standard approaches.
Case Report (n=1)
Detailed echocardiography and lung ultrasound are crucial in post-cardiovascular surgery shock to identify dynamic LVOT obstruction, which requires a specific management strategy of volume expansion and inotrope discontinuation.
May prompt consideration of dynamic LVOT obstruction in unexplained post-nonmitral surgery LCOS; leaves open incidence and optimal management.
Background. The dynamic obstruction of the left ventricular outflow tract (LVOT) is a well-known complication in mitral annuloplasty but rarely seen in nonmitral cardiovascular surgery. The dynamic LVOT obstruction can lead to hemodynamic instability, even shock and the treatment is significantly different from the standard approach. Case Presentation. We reported a case of low cardiac output syndrome (LCOS) with severe mitral regurgitation (MR), dramatically reduced left ventricular ejection fraction (LVEF) after coronary artery bypass grafting in a 72-year-old female requiring an escalation of inotropic support, volume restriction, and mechanical support. The detailed echocardiography combined with lung ultrasound revealed a dynamic systolic anterior movement of the anterior mitral leaflet (SAM), apical ballooning, and no significant lung congestion. Intravenous fluids were given, diuretics withdrawn, inotrope discontinued, and vasopressors uptitrated. The dynamic SAM was rapidly relieved, the hemodynamics was stabilized, and the LVEF was improving. The patient was discharged in good condition without residual LVOT obstruction and trace MR. Conclusion. We strongly suggest that a detailed echocardiography should be performed in any patient who presents in shock to rule out a dynamic LVOT obstruction. Lung ultrasound should be a routine examination in addition to echocardiography. Once SAM is detected, treatment should be based on volume expansion, inotrope discontinuation, and a careful afterload increasing.
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Bắc et al. (2020) conducted a case report in Cardiogenic shock secondary to dynamic LVOT obstruction and apical ballooning after CABG (n=1). Volume expansion, inotrope discontinuation, and vasopressor uptitration was evaluated on Hemodynamic stabilization and relief of dynamic SAM. Treatment with volume expansion, inotrope discontinuation, and vasopressor uptitration rapidly relieved dynamic systolic anterior movement and stabilized hemodynamics in a patient with cardiogenic shock post-CABG.
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